POST-OP SHOULDER GROUP PROTOCOL

ASAD
WEEK 1-2

GOALS
Decrease Pain
Re-estabilish non-painfull range of motion
Re-estabilish scapulo-humeral rhythm
Re-estabilish scapula stabilisation
Prevent muscle inhibition and atrophy

PRECAUTIONS
Cryocuff 10min/hr
Sling- even when sleeping
No supporting of body weight by hands

EXERCISES
Joint and Soft tissues mobilisation
Pendulum exercise
Gentle autopassive distraction
PROM painfree (MD Pain management)
o Flx as tolerated on scapula plane
o Abd 60 deg.
o Ext. rot. as tolerated
o Int. rot. 0 deg.
AAROM: painfree arc motion
o Wall climbs
o Bed walk sitting progress to prone
o Pulley
Strengthening
o Prone: scapula fixation exs in all positions
o Rythmic stabilization exs (IR/ER flx/ext)
o Isometrics all directions
o Triceps/ biceps isotonic with theraband/ dumbbells
o IR/ER theraband
 o Add.
Proprioception at 0 deg.

CRITERIA TO PASS TO INTERMEDIATE GROUP

o Full AArom minimum Pain at end Flx; ER 30-30 deg.
o Good scapula-humeral rythm

3-5 WEEKS

GOALS
Control Pain
Regain and improve muscle strength
Improve shoulder neuromuscular control
Restore full ROM

EXERCISES
Pain control with ice and modalities
o may use heat prior to exs program
Joint mobilization:
o Inferior, posterior and anterior glide
o Capsular stretch (posterior )
Continue ROM exs
Strengthening:
o start isotonic program NO Weight
o if painfree exs 1 lb weight after 1 wk
shoulder elevation
prone rowing
prone horizontal abd. thumb up
sidelying ER
abd to 90 deg.
ext to neutral
Proprioception: progress at 90 deg.
Neuromuscular program for scapular muscles
Start trunk and lower extremity exs
Endurance exs
o Arm bike
o Ellyptical
 Hydrotherapy

CRITERIA TO PASS TO NEXT PHASE

Full pain-free ROM
No pain or tenderness
Strength 70% MMT >4/5

WEEK 6-12

GOALS
Improve strength, power, endurance
Improve neuromuscular control
Prepare athlete to return to sport

EXERCISES
Continue ROM programme
Strengthening:
o Continue isotonic program
o Progress to eccentric programme (ER ++)
o Progress to CKC as tolerated
o Isokinetic short arc, mid speed, progress to full ROM, all speed
o Continue neuromuscular program for scapular muscles
Continue endurance exs
Proprioception: progress to body load exs
Functional
o Start throwing progression
2 hands progress to 1 hand
Plyometric activities
Wall dribbles
Baseball throws

CRITERIA TO PASS TO NEXT PHASE

Full pain-free AROM
No pain or tenderness after activities
Isokinetic test ER/IR (60-180-300 deg) 90% compared to the
controlateral side
WEEK 13-16

GOALS
o Return to sport

EXERCISES
o Continue ROM and Strengthening program
o Continue neuromuscular program for scapular muscles
o Functional exs specific for sport

CRITERIA TO BE DISCHARGE
o Full AROM pain-free
o No pain or tenderness after activities
o Functional tests 90% compared to the controlateral side
o Biodex test ER ecc./ IR conc. 90% compared to the controlateral side
o Questionnaire